As owners of SOS Alarm, which operates Sweden's emergency telephone number 112 and other related services, ramp up pressure for the company to attain higher profits, several counties remain dissatisfied with the skills of the emergency operators.
So far, three counties cancelled their contracts with SOS Alarm, switching instead to an alternative response source.
The board for SOS Alarm introduced revenue requirements last fall for annual profit margins to reach at least 12 percent, last year it stood at 0.5 percent.
According to Chairman John Magnusson (M), staff should be reduced with new technology, and more emergency calls are redirected to other call centres elsewhere in the country than from where calls originated, according to national newspaper Dagens Nyheter (DN).
DN's review of SOS Alarm indicates that the county's criticism in recent years has grown due to staffing issues both in terms of sufficient numbers and medical knowledge.
A report by daily newspaper showed there are times that only three SOS Alarm nurses are on staff during the day in Stockholm, a city of more than two million inhabitants.
Demands have also been made for call operators to be nurses due to the large number of emergency calls requiring medical expertise.
Last year 18.5 percent of emergency calls resulted in an ambulance response with 975,000 ambulance missions carried out over the country.
The calls are answered by alarm operators who are not required to have basic medical training but instead receive an introduction to basic first aid response during their first shift.
Nurses are connected only when needed.
Three counties and Region Gotland have terminated their contracts with SOS Alarm and transferred services to MedHelp, who requires all employees have a nursing education.
SOS Alarm is jointly owned by the state and the Swedish Association of Local Authorities and Regions (Sveriges Kommuner och Landsting, SKL).